Graft-versus-host disease (GVHD)

Mechanism
  • Complication of allogenic hematopoietic stem cell transplantation
  • Caused by cytotoxic action of the donor’s T lymphocytes on the recipient’s tissues
 
Clinical presentation
  • Acute manifestions (first 100 days adter transplantation)
    • Skin: erythematous or erythematosquamous, similar to toxic dermatitis
      • May be localized or diffuse
      • NET like pattern in most severe form
      • Treatment: increase immunosuppression
  • Chronic
    • Skin
      • Sclerodermiform forms → similar to morphea
        • Localized to pansclerotic
        • Difficult to treat, immunosupressants are often disappointing, physical therapy is essential
      • Lichenoid form
        • Similar to lichen planus
    • Other organs
      • Ocular: dry syndrome with synechial blepharoconjunctivitis
      • Oral mucosa: microstomia, erosions
      • Genital mucosa (erosive lichen sclerosus)
      • Sclerotic leukomelanoderma
 
Treatment (often hematology)
  • Immunosupression
    • JAK and tyrosine kinase inhibitors
    • Photopheresis
    • topical corticosteroids
    • Emollients
    • Physical therapy
 
Ophtalmological and oral follow-up